M56_BB Tham Dinh Phong Kham Da Khoa_NCL

7/28/2019 M56_BB Tham Dinh Phong Kham Da Khoa_NCL

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M u 56(Ban hnh km theo Quy t nh s 617/Q-UBND-HC

ngy 28 thng 6 nm 2013 caCh tchUBND t nh ng Thp)

UBND T NH NG THP S Y T

CNG HO X HI CH NGHA VIT NAM c lp- T do- Hnh phc

...... ............... .... , ngy....... thng... .....nm 20....

BIN BN THM NH PHNGKHM A KHOA.....................

I. THNG TIN V C S C THM NH 1.Tn c s khm bnh, cha bnh: 2. a ch: 3. in thoi:. Email (n u c): 4. Fax: .

II. THNH PHN THAM GIA THM NH A. Thnh phn on thm nh + S Y t:

1. .......................................................; Ch c v:........................................... 2. .......................................................; Ch c v:...........................................3. .......................................................; Ch c v:........................................... 4. .......................................................; Ch c v:...........................................

+ Phng Y t : 1 .......................................................; Ch c v:............................................ 2. . ......................................................; Ch c v:............................................

B. i din ca c s c thm nh: 1. ..2.

III. CN C PHP L THM NH - Cn c Lut Khm bnh, cha bnh ngy 23 thng 11 nm 2009; - Cn c Ngh nh s 87/2011/N-CP ngy 27 thng 9 nm 2011 quy nhchi tit thi hnh m t s iu ca Lut khm bnh, cha bnh; - Cn c Thng t s41/2011/TT- BYT ngy 14/11/2011 c a B Y t hng

d ncp chng ch hnh ngh i vi ngi hnh ngh v cp giy php hotng i vi c s khm bnh, cha bnh.

- Theo n ngh cp giy ph p hot ng khm bnh, cha bnh ca ng(B): IV. NI DUNG THM NH1. H s php l: ( Lit k y cc giy t c lin quan)


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...

Nhn xt:..........2. T chc b my:

C s khm bnh, cha bnh c qui m........................c t chc nh sa a. B phn qun l:

- Ba n gim c Ch c s - Cc phng: ...

b. B phn chuyn mn: ( Bao g m cc khoa/ phng chuyn khoa )

- .......- ... Nhn xt:.....

3. T chc, nhn s:

a. C s c tng s nhn vin: ...... ngi; trong nhn vin lm cng vi cchuyn mn: ....... ngi. TT Chc danh Phng hnh

chnhLm sng Cn lm

sngDc

a) Tng s Y, Bc s - Tin s y hc - Thc s y khoa - Chuyn khoa II - Chuyn khoa I - Bc s - Y s lm cng tc iutr b) Tng s Dc - Thc s - Chuyn khoa II - Chuyn khoa I - Dc s i hc - Dc s Trunghc/KTV dc TH - Dc t (s hc) c) Tng s iu dng


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- Tin s / Thc s iudng - i hc iu dng - Cao ng iu dng - Trung h c iu dng - S hc iu dng d) Tng s N h sinh - Thc s h sinh - i hc h sinh - Cao ng h sinh - Trung h c h sinh - S hc h sinh e) Tng s K thutvin Y- Thc s - i hc - Cao ng - Trung h c - S hc f) Tng s cc cn bkhc:- Thc s/ Tin s - i hc

- Cao ng - Trung h c - S hc Tng s

TT Ch c danh Hp ng lm victhng xuyn (ton th igian)

Hp ng lm vickhng thng xuyn(mt phn thi gian)

Tng s

a) Tng s Y, Bc s - Tin s y hc

- Thc s y khoa - Chuyn khoa II - Chuyn khoa I - Bc s - Y s lm cng tciu tr b) Tng s Dc - Thc s - Chuyn khoa II


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- Chuyn khoa I - Dc s i hc - Dc s Trunghc/KTV dc TH - Dc t (s hc) c) Tng s iudng- Tin s / Thc s iudng - i hc iu dng - Cao ng iu dng - Trung h c iudng - S hc iu dng d) Tng s N hsinh- Thc s h sinh - i hc h sinh - Cao ng h sinh - Trung h c h sinh - S hc h sinh e) Tng s K thutvin Y- Thc s - i hc - Cao ng - Trung h c - S hcf) Tng s cc cn bkhc:- Thc s/ Tin s - i hc - Cao ng - Trung h c - S hc Tng s

b. Ngi chu trch nhim chuyn mn k thut phi c chng ch hnh ngh v thc hin vic khm bnh, cha bnhtrong ph m vi phn cng

t Khng t 4. C s vt cht:

- Din tch chungm2, (di.m. x r ngm.......); - K t cu nh ................................................................


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- Tr n nh chng biv c chi u cao ti thiu l 3,1 m:t Khng t

- Tng v nn s dng vt liu d ty ra lm v sinh t Khng t

- nh sng t Khng t - Tch bi t vi ni sinh hot gia nh t Khng t - C s ng k .khoa , trong :

+ Khoa .+ Khoa ..

+ Khoa + Khoa ..

+ Khoa + Khoa ..- C s c bin hiu ng qui nh (tn c s, a ch, gi l m vic, ngi ph

trch, in thoi..) t Khng t

4.1. Phng tip nhn: - C ni tip n ngi bnh t Khng t - C ni ngi bnh ngi ch t Khng t

4.2. Phng cp cu: - C di n tch 12m 2 t Khng t

4.3. Phng lu bnh: - C di n tch 15m 2 (nu c 02 gi ng lu bnh) ho c 05 m 2/ gi ng

(nu c 03 gi ng lu bnh) t Khng t 4.4. Phng khm:

- Miphng khm chuyn khoa c di n tch 10m2

- Mi bungththut/ tiu phu (i vic din tch 10m 2

- Bung vn ng tr liu (nu c) din tch 40m 2

TT Tn Phng khm, bung th thut Din tch t Khng t

4.5. Phng X quang, CT Scan, MRI:a. Phng X quang c b tr:

- C ni tip n ngi bnh t Khng t


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- C ni ngi bnh ngi ch t Khng t - Phng r a phim, in nh t Khn g t - C b ng quy nh vn hnh thi t b t Khng t - S lu kt qu t Khng t - H thng lu tr, bo qun phim (t , nhit k,)

t Khng t - H thng PCCC t Khng t b. Vic thit k, xy d ng phng X quang ph i m bo cc yu cu sau: - Phng t thit b phi thong rng, trn nh cao t nh t 3m50

t Khng t - Tng gch trt bart t Khng t - Ca c p tm ch t Khng t - Nn nh cao ro t Khng t - ng in m bo an ton v cng sut cho my hot ng

t Khng t 4.6. Phng Siu m:

- Phng siu m ph i rng 10 m 2, c mn che nh sng, iu hanhit , ging, gh ch,... t Khng t

- C b ng quy nh v s dng v bo qun my, trang thit b. t Khng t

4.7. Phng xt nghim - Din tch ti thiu14 m 2 (3 bn xt nghi m)

t Khng t - Sn:+ Sn gi a cc khng gian khng chnh ct, khng c g ca m bo

phng, nhn, khng trn trt, chu c ho cht, chng thm v d c ra vsinh. t Khng t

+ Sn bn trong cc phng r a tit tr ng, chu n b mi trng chun bmu phi chng trn, thu nc khi cr a. t Khng t

+ Giao tuy n ca sn vi tng m bo d v sinh, chng ng v bm bi. t Khng t

- Tng: + Tng c hon thin bng vt liu cht lng cao m bo lp c

ph b mt phng, nhn. t Khng t + Tng bn trong cc phng labo s dng vt liu chng thm, chng n

mn ho ch t, d c ra, sn khng khun. t Khng t - Tr n:


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Tr n phi c b mt phng, nhn(khng bm b i)chng thm v phi pnglp t c cc thit b(chiu sng, phng chy ch a chy, iu ho khngkh v cc thi t b k thut...) t Khng t

- Phng xt nghi m v sinh sch s, khng dn giy, ng inh ln tng

t Khng t - Thng rc c n p y theo ng quy nh rc

t Khng t ( Trng hp Phng khm c t chc phng xt nghi m vi sinh phi m

bo theo tiu chu n quy nh ti Thng t s 29/2012/TT -BYT ngy 04/12/2012ca B trng B Y t Quy nh th tc cp mi, cp li giy chng nhn phng

xt nghi m t tiu chu n an ton sinh h c)5. in, nc, v sinh, v sinh mi trng, phng chy cha chy:

- H thng in, h thng nc m bo; c trang b labo ra tay, ra dn t Khng t

- m bo cc iu kin x l cht thi v v sinh mi trng t Khng t

- H thng PCCC t Khng t - Phng v sinh t Khng t

6. Trang thit b dng c y t: - Danh m c trang thit by t (nh k m bin b n)

t Khng t

- C s thuc v d ng c cp cu ng quy nh t Khng t

- Lp l lch, xy dng ni quy, quy nh vn hnh thi t b, thc hin ch bo dng thng xuyn v nh k(nu cs dng my)

t Khng t 7. Phm vi hnh ngh c th:

..

....8. Quy trnh k thut

1. C b ng quy tr nh k thut y t Khng t 2. Bo m an ton cho ngi bnh khi thc hin cc k thut

t Khng t 3. Thc hin vic k n thuc, bnh n t Khng t 4. Ghi s lu kt qu y t Khng t


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9. Gi dch v d kin:................................................................................... .............................................................................................................................V. KT LUN V KIN NGH

1. Kt lun:..

2. Kin ngh: ........................

3. kinkhngng vi kt lun v kin ngh ca on thm nh(nuc).....

............

Bin b n kt thc lc gi pht, cng ngy.TRNG ON PHNG Y T TH K

I DIN C S C THM NH

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M56_BB Tham Dinh Phong Kham Da Khoa_NCL